Temporal trends in mortality from respiratory failure among adults with cancer in the united States from 1999 to 2020: a CDC database analysis

Neoplasm is the leading cause of mortality and morbidity in the US. Its common complication is respiratory failure, which can be fatal and terminal. Due to the limited amount of data, our study examines age-stratified trends in death due to neoplasm and respiratory failure in US adults aged 25 years and older from 1999 to 2020. Mortality data were extracted from the CDC WONDER database. Both neoplasm and respiratory failure were documented as multiple causes of death. Age-adjusted mortality rates (AAMRs) per 100,000 individuals were calculated, and trends were analyzed using Joinpoint regression software which was used to determine the annual percent change (APC) with 95% confidence intervals. From 1999 to 2020, the AAMR for deaths involving both neoplasms and respiratory failure increased from 21.4 (95% CI 21.19–21.62) to 27.1 (95% CI 26.88–27.28), with an initial decline from 1999 to 2004 (APC: − 1.5164; 95% CI − 2.4689–0.5546), followed by a moderate increase from 2004 to 2012 (APC: 0.8868; 95% CI 0.3332–1.4434) and then a significant increase from 2012 to 2020 (APC: 2.9767; 95% CI 2.5864 to 3.3685). Highest rate was reported in 2020 during the COVID-19 pandemic. Mortality rose with age, with adults aged 85 + having highest overall crude rates (129.42, 95% CI 128.78–130.07) and 25–34 years having lowest (0.89; 95% CI 0.87–0.91). Sex disparities persisted, with males having higher mortality rates (27.67, 95% CI 27.60–27.74) than females (18.31, 95% CI 18.25–18.36). Racial disparities were evident, with the highest rate among Black individuals (25.73; 95% CI 25.58–25.87) followed by Whites (22.00; 95% CI 21.95–22.04); Hispanic, Asian, and American Indian/Alaska Native populations had lower rates, though the latter showed instability due to small counts. Geographically, the West region had the highest mortality (24.82; 95% CI 24.72–24.92), and rural areas had consistently higher mortality compared to urban, with micropolitan counties having highest overall AAMR (23.74; 95% CI 23.60–23.88) and a pronounced rise after 2010. State-level variation ranged from 10.4 (Wisconsin) to 37.2 (Mississippi). Mortality trends of neoplasm and respiratory failure have risen from 1999 to 2020, with persistent racial and geographical disparities, particularly higher rates among black individual and those in rural or less developed areas. These racial and geographical disparities highlight the need for integrated care strategies and resource allocation.